In the early weeks of
development, long before a child is born, the right and left sides
of the lip and the roof of the mouth normally grow together.
Occasionally, however, in about one of every 800 babies, those
sections don't quite meet. A child born with a separation in the
upper lip is said to have a cleft lip. A similar birth defect in the
roof of the mouth, or palate, is called a cleft palate. Since the
lip and the palate develop separately, it is possible for a child to
have a cleft lip, a cleft palate, or variations of both.
If your child was born with either or both of these conditions,
your doctor will probably recommend surgery to repair it. Medical
professionals have made great advances in treating children with
clefts and can do a lot to help your child lead a normal, healthy,
happy life.
This information will give you a basic understanding of the
operation -- when it can help, how it's performed, and what results
you can expect. It can't answer all of your questions, since a lot
depends on you individual circumstances. Please be sure to ask Dr.
Rieger if there is anything you don't understand about the
procedure.
THE IMPORTANCE OF A TEAM APPROACH
Children born with a cleft lip or palate may need the skills of
several medical professionals to correct the problems associated
with the cleft. In addition to needing plastic surgery to repair the
opening, these children may have problems with their feeding and
their teeth, their hearing, their speech, and their psychological
development as they grow up.
For that reason, parents should seek the help of a Cleft Lip and
Palate Team as early as possible. Medical professionals with special
experience in the problems of cleft lip and palate have formed such
teams all over the country to help parents plan for their child's
care from birth, or even before. Typically, a Cleft Team might
include a plastic surgeon, a pediatrician, a dentist, a speech and
language specialist, a social worker, a hearing specialist, an
ear-nose-throat specialist, a psychologist, a nurse, and a genetic
counselor.
ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK
When surgery is done by a qualified plastic surgeon with
experience in repairing cleft lip or palate, the results can be
quite positive. Nevertheless, as with any operation, there are risks
associated with surgery and specific complications associated with
this procedure.
In cleft lip surgery, the most common problem is asymmetry, when
one side of the mouth and nose does not match the other side. The
goal of cleft lip surgery is to close the separation in the first
operation. Occasionally, a second operation may be needed.
In cleft palate surgery, the goal is to close the opening in the
roof of the mouth so the child can eat and learn to speak properly.
Occasionally, poor healing in the palate or poor speech may require
a second operation.
PLANNING FOR SURGERY
At your initial consultation, your doctor will discuss the
details of the procedure he or she will use, including where the
surgery will be performed, the type of anesthesia to be used,
possible risks and complications, recovery, costs, and the results
you can expect. Your surgeon will also answer any questions you may
have about feeding your baby, by breast or by bottle, both before
and after the surgery.
In most cases, health insurance policies will cover most or all
of the cost of cleft lip or cleft palate surgery. Check your policy
to make sure your child is covered and to see if there are any
limitations on what types of treatment are covered.
CLEFT LIP SURGERY
A cleft lip can range in severity from a slight notch in the red
part of the upper lip to a complete separation of the lip extending
into the nose. Clefts can occur on one or both sides of the upper
lip. Surgery is generally done when the child is about 3 months old.
A cleft lip is a separation of the upper lip that can extend
into the nose.
To repair a cleft lip, the surgeon will make an incision on
either side of the cleft from the mouth into the nostril. He or she
will then turn the dark pink outer portion of the cleft down and
pull the muscle and the skin of the lip together to close the
separation. Muscle function and the normal "cupid's bow" shape of
the mouth are restored. The nostril deformity often associated with
cleft lip may also be improved at the time of lip repair or in a
later surgery.
To repair a cleft lip, the surgeon will first make an
incision on each side of the cleft from the lip to the nostril.
The cleft lip is then drawn together and stitched to create a
normal "cupid's bow" shape to the upper lip.
The scar left after surgery will gradually fade with time.
RECOVERING FROM CLEFT LIP SURGERY
Your child may be restless for awhile after surgery, but your
doctor can prescribe medication to relieve any discomfort. Elbow
restraints may be necessary for a few weeks to prevent your baby
from rubbing the stitched area.
If dressings have been used, they'll be removed within a day or
two, and the stitches will either dissolve or be removed within five
days. Your doctor will advise you on how to feed your child during
the first few weeks after surgery.
It's normal for the surgical scar to appear to get bigger and
redder for a few weeks after surgery. This will gradually fade,
although the scar will never totally disappear. In many children,
however, it's barely noticeable because of the shadows formed by the
nose and upper lip.
CLEFT PALATE SURGERY
In some children, a cleft palate may involve only a tiny portion
at the back of the roof of the mouth; for others, it can mean a
complete separation that extends from front to back. Just as in
cleft lip, cleft palate may appear on one or both sides of the upper
mouth. However, repairing a cleft palate involves more extensive
surgery and is usually done when the child is nine to 18 months old,
so the baby is bigger and better able to tolerate surgery.
When the roof of the mouth doesn't grow together properly,
the condition is called a cleft palate. To repair it, the surgeon
will make an incision along both sides of the cleft.
To repair a cleft palate, the surgeon will make an incision on
both sides of the separation, moving tissue from each side of the
cleft to the center or midline of the roof of the mouth. This
rebuilds the palate, joining muscle together and providing enough
length in the palate so the child can eat and learn to speak
properly.
Tissue is drawn together from both sides of the cleft to
rebuild the roof of the mouth.
RECOVERING FROM CLEFT PALATE SURGERY
For a day or two, your child will probably feel some soreness and
pain, which is easily controlled by medication. During this period,
you child will not eat or drink as much as usual -- so an
intravenous line will be used to maintain fluid levels. Elbow
restraints may be used to prevent your baby from rubbing the
repaired area. Your doctor will advise you on how to feed your child
during the first few weeks after surgery.
THE REPAIRED LIP OR PALATE
Children with a cleft palate are particularly prone to ear
infections because the cleft can interfere with the function of the
middle ear. To permit proper drainage and air circulation, the
ear-nose-and-throat surgeon on the Cleft Palate Team may recommend
that a small plastic ventilation tube be inserted in the eardrum.
This relatively minor operation may be done later or at the time of
the cleft repair. In addition, surgery may be recommended by your
plastic surgeon when your child is older to refine the shape and
function of the lip, nose, gums, and palate.
You'll want to discuss further needs with the members of the
Cleft Team seeing your child.
Perhaps most important, keep in mind that surgery to repair a
cleft lip or palate is only the beginning of the process. Family
support is critical for your child. Love and understanding will help
him or her grow up with a sense of self-esteem that extends beyond
the physical defect.
call 316-652-9333 for a consult about Cleft Craft Surgery in
Wichita, Kansas.
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Brochure © 2003 American Society of Plastic Surgery
